Hymel Kent P, Armijo-Garcia Veronica, Foster Robin, Frazier Terra N, Stoiko Michael, Christie LeeAnn M, Harper Nancy S, Weeks Kerri, Carroll Christopher L, Hyden Phil, Sirotnak Andrew, Truemper Edward, Ornstein Amy E, Wang Ming
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Departments of Pediatrics, and
Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas;
Pediatrics. 2014 Dec;134(6):e1537-44. doi: 10.1542/peds.2014-1329. Epub 2014 Nov 17.
To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.
We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR.
In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT.
Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.
为减少儿童虐待性头部创伤（AHT）的漏诊病例，儿童脑损伤研究网络的研究人员制定了一个包含4个变量的AHT临床预测规则（CPR），其灵敏度为0.96。我们的目的是在一个新的、等效的患者群体中验证该AHT CPR的筛查性能。
我们进行了一项前瞻性、多中心、观察性横断面研究。应用与已完成的推导研究相同的纳入标准、AHT的定义标准和方法，儿童脑损伤研究网络的研究人员收集了14个参与地点入住儿科重症监护病房（PICU）的291名3岁以下急性头部受伤儿童的完整临床、病史和放射学数据，将他们分为虐待性和非虐待性头部创伤的比较组，并测量AHT CPR的筛查性能。
在这个新的患者群体中，4变量AHT CPR的灵敏度为0.96，特异度为0.46，阳性预测值为0.55，阴性预测值为0.93，阳性似然比为1.67，阴性似然比为0.09。二次分析显示，AHT CPR识别出了最终被诊断为AHT的98%的研究患者。
四个易于获得的变量（入院前急性呼吸功能不全；躯干、耳部或颈部瘀伤；双侧或半球间硬膜下出血或积液；以及除孤立的、单侧的、非分离的、线性的顶骨骨折以外的任何颅骨骨折）在入住PICU的年轻急性头部受伤儿童中能以高灵敏度识别AHT。
